<!DOCTYPE html>
<html style="font-size: 40px;">
<head>
	<title>医院挂号</title>
	{dede:include filename="header.htm"/}
	<script type="text/javascript" src="/templets/phoneThyroid/js/online.js"></script>
</head>
<body>
	<div class="yygh">
		<div class="logo">
			<img src="/templets/phoneThyroid/images/gh_04.png"></div>
		<div class="clear"></div>
		<div class="xyygh">
			<h2>免费预约·无需排队·优先就诊</h2>
			<form id="myform" method="post" action="http://mail.jszjrzk.com/thyroid/phone" accept-charset="utf-8">
				<div class="ghxm">
					<li>
						姓
						名：
					</li>
					<input type="text" id="name" name="name"></div>
				<div class="ghdh">
					<li>
						电
						话：
					</li>
					<input type="text" id="phone" name="phone"></div>
				<div class="ghbz" style="display:none;">
					<li>预约专家：</li>
					<select class="zj_sel" name="doctor">
						<option value="赵为国">赵为国</option>
						<option value="戴晓江">戴晓江</option>
					</select>
				</div>
				<div class="ghbz">
					<li>预约病种：</li>
					<select name="entity" id="entity">
						<option value="甲状腺结节">甲状腺结节</option>
						<option value="甲亢">甲亢</option>
						<option value="甲减">甲减</option>
						<option value="桥本氏病">桥本氏病</option>
						<option value="甲状腺炎">甲状腺炎</option>
						<option value="甲状腺囊肿">甲状腺囊肿</option>
						<option value="甲状腺肿大">甲状腺肿大</option>
						<option value="甲状腺腺瘤">甲状腺腺瘤</option>
						<option value="桥本腺瘤">桥本腺瘤</option>
						<option value="检查">检查</option>
						<option value="未知">未知</option>
					</select>
				</div>
				<div class="ghdh">
					<li>预约时间：</li>
					<input type="date" id="time" name="date"></div>
			</form>
		</div>
		<div class="ghtj">
			<a href="tel:02081659126" class="ghtj1"> <i></i>
				020-81659126
			</a>
			<input class="ghtj2 sub_btn" type="button" value="提交挂号">
		</div>
	</div>
</body>
</html>